I welcome the Bill. We all recognise the benefits of being able to allow people who need some level of support to remain independently in their homes as long as possible. In amending the Health Act 2007, the legislation will create the first statutory regulatory framework for home support providers, with mandatory registration, HIQA-led standards, inspections and criminal penalties for unregistered operators, bringing Ireland into line with other jurisdictions, including our neighbours in the UK. This is all well and good, but it is about the enforcement. Over the years, the HSE has been gradually outsourcing services for older people and persons with disabilities to private companies. Between 2018 and 2022, the total home support hours increased by 22% but the HSE-delivered hours only increased by 7.6%. By 2023, according to HSE data analysed by Home and Community Care Ireland, the independent sector, made up largely of private operators and a small number of voluntary community providers, made up 61% of all home support hours, with the HSE only accounting for 39%. The outsourcing trend has been driven by a number of factors, not least that the HSE is struggling to recruit and retain home support workers due to public sector pay issues, rostering and the basic demographics of the country with an ageing population, creating a demand that apparently rose faster than the HSE could hire staff or pay for them directly. This is what has led us to this situation where we are dependent on an insufficiently regulated sector and we need to bring in meaningful legislation. Hopefully, this is meaningful. With so many private operators, there are massive turnovers of staff, and the risk to the patient care is suited to fit the schedule of the company rather than the needs of the client. I have seen this myself where a constituent who was catered for directly from the HSE was shifted into a calendar that did not suit her needs. However, when you try to raise issues with the provider, you are routinely ignored. There are no checks and balances or parliamentary questions, only an indirect means of seeking an inspection. This is why an enforceable, HIQA-led standard is important, along with a system of proper inspections, stiff penalties for companies that operate without being registered and meaningful consequences for operators that do not provide adequate levels of care for clients. Of course, these higher standards may require more training and more staffing in a sector already facing shortages, which may mean people rightly needing to be paid more. That is all well and good, but the Minister of State needs to accommodate the additional outsource costs. We need guarantees that people will be paid properly. Compliance demands could also reduce the available care hours. We need some form of grant system to ensure that the companies will do this without taking away the actual hours for service. Ultimately, what we are trying to do is keep people at home. This legislation, by the time it is scrutinised and amended, will hopefully create the framework. The resources for training, inspection and enforcement absolutely need to be provided, as well as measures to make the sector more attractive for the additional workers needed.

Sentiment score: 0.31